Vitamin D Fails to Relieve Anemia in Dialysis Patients

But supplementation may have other benefits, experts advise

Vitamin D supplements were no help for treating anemia in patients with end-stage renal disease (ESRD) on dialysis, according to a randomized, double-blind, placebo-controlled trial published in the Journal of the American Society of Nephrology.

Six months of vitamin D supplementation did not reduce patients' need for epoetin compared with placebo, reported a team of investigators led by Dana Miskulin, MD, of Tufts Medical Center in Boston.

The study also found no effect of vitamin D on secondary outcomes including parathyroid hormone levels and markers of inflammation, Miskulin and colleagues said.

Nevertheless, vitamin D supplementation may still have other benefits in this patient population, such as maintaining bone health, Miskulin said in an interview with MedPage Today.

"This study definitively showed no effect of vitamin D on anemia or parathyroid hormone levels. There are larger, ongoing population studies that will answer questions about vitamin D and other clinical outcomes such as cardiovascular disease and cancer," Miskulin said.

The current study included 276 adult ESRD patients on hemodialysis. Mean baseline serum vitamin D level was 16 ng/ml. The participants were randomized to receive either weekly vitamin D supplementation (50,000 IU ergocalciferol) or placebo for 6 months. The study's main outcome measure was change in epoetin dose.

The study found no significant change in epoetin use over the 6 months in the treatment or placebo group (P=0.78).

The researchers reported no change in intact parathyroid hormone levels, serum calcium, phosphorus, C-reactive protein levels, cinacalcet use, phosphate binder dose, or calcitriol dose in either study group. Rates of all-cause, cardiovascular, and infection-related hospitalizations; rates of falls; and rates of fractures did not differ by study group, although the statistical power of the relatively small study was limited for these outcomes, the investigators noted.

"From the present study, we can conclude that nutritional vitamin D has no role to play in the management of anemia in dialysis patients," the study authors concluded.

Despite these findings, "We can't say that vitamin D has no beneficial effect in this patient population. It wouldn't be right to stop vitamin D supplementation on the grounds of this study," Miskulin told MedPage Today.

Beth Piraino, MD, a nephrologist and researcher at the University of Pittsburgh School of Medicine, and past president of the National Kidney Foundation, agreed.

"The results as to the primary outcome (does supplementation with ergocalciferol have a role in anemia management) are convincingly no," Piraino said in an email to MedPage Today. "This does not mean that ergocalciferol might not be worthwhile for other reasons not studied in this paper. For example, perhaps replacing vitamin D might increase muscle strength. The authors are not studying this question."

The results suggest that "dialysis units should not depend on giving ergocalciferol to help correct anemia. This does not mean that dialysis units should stop replacing vitamin D with ergocalciferol," Piraino said. "In my unit...we routinely measure 25 OH vitamin D levels and give ergocalciferol weekly or monthly dependent on the levels."

"Unfortunately there are no data to suggest this is useful, but this is a benign drug and in absence of data that this is causing harm, it seems reasonable to correct a vitamin D deficiency/ insufficiency," Piraino said.

The study was funded by Dialysis Clinic (DCI).

All study authors were either employed by DCI, received salary support from DCI, or were DCI medical directors. No authors disclosed additional competing financial interests.

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